JMIR Publications

ABSTRACT

Background:

Digital interventions integrating gamification features hold promise to promote physical activity (PA). However, results regarding the effectiveness of this type of intervention are heterogeneous and not yet confirmed in real-life contexts.

Objective:

This study aimed to examine the effectiveness of a gamified intervention and its potential moderators in a large sample using real-world data. Specifically, we tested (1) whether a gamified intervention enhanced daily steps during the intervention and follow-up periods compared to baseline, (2) whether this enhancement was higher in participants to the intervention than in nonparticipants, and (3) what participants’ characteristics or intervention parameters moderated the effect of the program.

Methods:

Data from 4819 individuals who registered for a mHealth Kiplin program between January 1st, 2019, and January 2nd, 2022 were retrospectively analyzed. In this intervention, participants could take part in one or several games where their daily step count was tracked, allowing individuals to play with their overall activity. Nonparticipants are people who registered to the program but did not take part in the intervention and were considered as a control group. PA was assessed via the daily step count of participants. Exposure to the intervention, the intervention content, and participants' characteristics were included in multilevel models to test the study objectives.

Results:

Compared with nonparticipants, participants who benefited from the intervention had a significantly greater increase in mean daily steps from baseline during the same period (p<.0001). However, intervention effectiveness was dependent on participants' initial PA. Whereas the daily steps of participants with <7500 baseline daily steps significantly improved from baseline both during the Kiplin intervention (+3291 daily steps) and during follow-up periods (+945 daily steps), participants with a higher baseline had no improvement or significant decreases after the intervention. Age (p <.0001) and exposure (p <.0001) positively moderated the intervention effect.

Conclusions:

In real-world settings and among a large sample, the Kiplin intervention was significantly effective to increase the daily steps of participants from baseline, during intervention and follow-up periods, and in comparison to nonparticipants. Interestingly, responses to the intervention differed as a function of individuals' initial PA with the existence of a plateau effect. Based on the insights of the self-determination theory, we can assume that the effect of gamification could depend of the initial motivation and activity of participants.